Managing Bias in Palliative Care: Professional Hazards in Goals of Care Discussions at the End of Life

Abstract

BACKGROUND: In the setting of end-of-life care, biases can interfere with patient articulation of goals and hinder provision of patient-centered care. No studies have addressed clinician bias or bias management specific to goals of care discussions at the end of life. OBJECTIVES: To identify and determine the prevalence of palliative care clinician biases and bias management strategies in end-of-life goals of care discussions. DESIGN: A semistructured interview guide with relevant domains was developed to facilitate data collection. Participants were asked directly to identify biases and bias management strategies applicable to this setting. Two researchers developed a codebook to identify themes using a 25% transcript sample through an iterative process based on grounded theory. Inter-rater reliability was evaluated using Cohen κ. It was 0.83, indicating near perfect agreement between coders. The data approach saturation. SETTING/PARTICIPANTS: A purposive sampling of 20 palliative care clinicians in Middle Tennessee participated in interviews. RESULTS: The 20 clinicians interviewed identified 16 biases and 11 bias management strategies. The most frequently mentioned bias was a bias against aggressive treatment (n = 9), described as a clinician's assumption that most interventions at the end of life are not beneficial. The most frequently mentioned bias management strategy was self-recognition of bias (n = 17), described as acknowledging that bias is present. CONCLUSION: This is the first study identifying palliative care clinicians' biases and bias management strategies in end-of-life goals of care discussions.